I'm sure I said, at some point, that it was a midstake for President Obama to say "if you like your plan/doctor, you can keep it/them," and not just for the pronoun disagreement.
I can't seem to find it anywhere on the blog, so probably I just say it in conversation, but I'm sure I said it.
It's interesting that this tension over "keep what you like" has become the dominant news story in the Failure of Obamacare storyline. Give conservatives credit for tripping over a storyline that finally works for them, though I'm pretty sure they don't understand why or how it can backfire.
Obama supporters, naturally, make excuses for their hero, but really, it was a dumb thing to say, one that betrayed at least some failure to appreciate the real problems in health insurance that needed reforming, probably due to lack of familiarity than (I suspect) a deliberate desire to mislead. In the wake of a dawning reality that at least some people - a lot, numerically, but a small percentage of all the insured - will lose health insurance plans they may have "liked," we are. imperfectly, moving into a discussion that may actually turn out to be healthy and necessary. Which is, again, why conservatives may want to be careful what they've wished for actually happening.
The discussion we've needed to have, of course, is the one where people finally get some education and information on the realities of healthcare and health insurance in America.
The facts are kind of complicated, and the details often get lost, but briefly: almost all health insurance plans change year to year. Reimbursement rates change, specific offerings change, details are tweaked, usually in ways that benefit the insurer and limit potential liabilities. For most people who get insurance through an employer, these changes are usually invisible and increased premiums are often largely absorbed by employers. If you've never been sick or seriously hospitalized, why would you know?
It's a somewhat different story for the about 10-11% of insured people who buy insurance on what's called the "individual market" or simply, buy a policy just for themselves or their family. These are the people who actually need a lot of what the ACA brought to insurance reform, because the exchanges solves a huge problem, by putting individuals into a group market, where their rates are likely to be better, and their benefits more secure. Individual policies have generally been phenomenally expensive, offered limited benefits, and were generally less secure than group policies from a large employer. In other words, if you actually got sick, and needed major care, you could often lose your insurance coverage at some crucial moment in an individual policy.
Individual policies also often change year to year, but the larger reality in that market is that the market changed even more year to year. You might spend a year starting your own business, only to decide to go back to a major employer. You might fail in your enterprise. Your business might take off and grow enough that you become a small business with employees and move into the small business market. The individual market experienced massive churn year over year (over year, over year). As such, consumers had virtually no power to ever keep a plan, no matter what they did, or how it was regulated. And many insurers either avoided the individual market or went in and out chaotically and unreliably.
This is why even the most well intentioned plans to "grandfather" existing indvidual insurance plans was doomed for most people; it's also why the proposals now in Congress to "fix" the "keep your plan problem" that would loosen rules are probably ludicrous as well. Insurers want the individual market to die and people to get pushed onto the Exchanges. That was the point of creating them. And for most people, that will be a generous improvement.
The problem is that many people don't understand anything about healthcare and health insurance. Individual market folks probably know more than most, because they have to, in order to make informed choices. But even there, lots of people don't get why the cost of underwriting individual policies made it generally pointless to offer them, and why a seemingly good policy could vanish with maybe a month's notice. Part of being entrepeneurial, really, is being flexible enough to work within a system that fluctuates and changes a lot, not expecting anyone to help you out. And that spirit, which I think often accompanies a distrust of government and liberalism, may explain why the rage of the past few weeks has been such a boon for the right, and such a surprise to the left.
It was a mistake for the President and his team to approach all of the healthcare changes as a marketing problem first, a political problem second, and a process problem third. Explaining the dtails and process issues around health insurance - detailing why more comprehensive, better defined policies would be an improvement for many people, as would a secure market where people outside traditional employment could shop as a group, would have gone miles ot prevent a number of the misunderstandings that now animate our healthcare debates. And leaving "like" out of the discussion altogether would have saved a lot of heartache and misinformation currently surrounding healthcare. It doesn't matter, after all, if you "like" your doctor; if your doctor is lousy in practice, but a nice person, liking him or her is irrelevant. Especially when it matters.
Similarly, "liking" a health insurance policy is pointless. A number of the anecdotes of people being dropped by insurers has revealed a love of seriously flawed plans that, say, failed to pay for hospitalization, or routine screenings, or chronic care. You may "like" the fact that a policy is cheap... but cheap may mean poor coverage and no help when you need it. And almost every plan offerred before the ACA will be replaced by a better, more comprehensive plan after.
Another lesson here - again - is that "governing by anecdote" itself is no way to make policy. Much of the noise we're dealing with around "keep your plan" ignores how few people are really affected in the indvidual market, how out of the ordinary many of the most extreme examples really are, or how little their problems really apply to anyone outside their narrow subsection of the insured. And that's what makes this story hard for those overly general "wrap it all up" pieces in the mass media - the story of what's happening to health insurance and individuals under the ACA is a different story in different states, and a different experience for nearly every person going through it. It's hard to generalize. And generalizing often leads to broad brush assertions that aren't realy true in many specific circumstances.
Like - "if you like your plan, you can keep it." Probably. For a lot of people. Except even the one you "keep" might very well change.
The upside - and I prefer to think in upsides - is that what we're getting is a wider, deeper exploration of healthcare issues than we've really ever had. A lot of people can learn something as a result of all this change, and many - probably most - people will have better coverage, and ultimately better access to and better actual care than they had before. Even the complainers.
But teh downside will, for some, be very real. Loss of insurance that worked just fine, new insurance that may cost more. If the Obama team continues to think of "handling" this, as treating all of the changes to healthcare as a mass marketing exercise in ideal messaging, then they will only have themselves to blame. The end result of making healthcare work better is not what people like, or what people keep. We don't need a sales job; we need a good process that leads to better outcomes. And getting there will still take some work.
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